Influence of community health workers on timing for TB management among patients with pulmonary tuberculosis in Dar es salaam, Tanzania

Abstract

Background: Although most deaths resulting from Pulmonary Tuberculosis (TB) in Tanzania can be prevented by early detection, TB case detection rate has remained low at 36%. A number of factors contributes to the low detection rate, among them being delays in TB management from both the client and facility perspectives. Though Community Health Workers (CHWs) have the potential to increase TB case detection rate evidence on their role on timing for TB management has not been explored. This study sought to establish the role of CHWs in timing for TB management among PTB patients in Dar es Salaam Region. Objectives: This study examined the influence of CHWs in timing for TB management among PTB patients in Dares Salaam. Methodology: A quantitative facility based cross sectional survey was conducted among 451 smear positive TB patients from selected health facilities in Dar es Salaam. Participants were interviewed regarding their knowledge on TB symptoms that lead to care seeking, the duration from onset of symptoms to receiving medical management, and whether a CHW was involved in the process of seeking care. Data on patients’ socio-demographics, facility and community based characteristics were also gathered. The SPSS statistical package was used for data analysis; descriptive statistics were used to summarise the data, while bivariate analysis was carried out to examine the association between CHWs involvement in care seeking with timing for medical management. A multivariate analysis was carried out to adjust for individual patients, community and facility factors that influence timing for medical care and the associations were set at the significance level of 0.05. Results: A total of 451 participants were recruited; more than half (69%) being males and most of them (40.7%) being 30-44yrs. About half (52.1%) of the patients sought care following prolonged cough, other symptoms being less presented. Although more than two thirds (71.6%) (self and community referrals) presented at the facilities timely, more than a half (58%) were delayed in receiving TB diagnosis. Only less than a quarter (20.6%) of the patients were community referrals. Self-referrals were significantly knowledgeable on vi prolonged cough (p = 0.03) and night sweats (p = 0.001) as TB symptoms. Though more than two thirds (72.5%) who sought care timely were self-referrals, the type of referral did not significantly influence timing for care seeking. A large majority (92%) of the patients received TB treatment timely; of these, self-referrals were 2.5 more likely to receive treatment timely than community referrals (p = 0.02). Conclusion; Although Community Health care workers were found not to influence the timing for TB management among pulmonary tuberculosis patients the study found that they reach higher proportion of patients with low level of TB knowledge which would implicitly improve their contact with the health care facilities for TB management. Recommendations; Community programs should be strengthened so as to ensure wide coverage and early detection of the missing TB cases. Further follow up studies are recommended so as to be able to show the exact influence of CHWs on the timing for TB management.